Lots of our Supporters gave us comments in support of our resolutions. We have sent them to the College, and they are displayed below – sorted alphabetically to preserve confidentiality.

A full review and open debate is required on all issues raised hre
AA are attempting to fill an artificial workforce gap. There are many doctors/anaesthetists who would like to either begin or continue training in anaesthesia but are blocked by issues such as rotational training (family/stress) and centralised recruitment. The workforce is there. Instead of training AAs why not train more anaesthetists. I work with AA but they were not helpful during COVID-19. They have limited training of critical care and maternity and cannot work on calls. They therefore take away daytime training opportunities from anaesthetists whilst those same anaesthetists have to take additional on call hours to cover the gapes caused by employing an AA. My department has tried a number of AAs for 5+years and has now decided to recruit no further. They are expensive, limited in their scope and require high levels of supervision with no ability to progress due to superficial understanding of the basic sciences. Our money and time is better spent recruiting speciality doctors who are cheaper and infinitely more useful.
AA is not the solution. More Anaesthetists is.
AAs are not the future of the college. Anaesthetists are the solution. Train more anaesthetists
AAs like PAs despite every good intention, serve to undercut trainees and medical training for anaesthesia, and even with good intentions as people that become colleagues and friends with limited scope for progression they WILL be given expanded roles to keep them, therefore overlapping what trainees should do.
AAs need direct supervision & complex procedures like blocks should not be in their scope of practice.

There are major issues in all NHS trusts w.r.t. competence of HR & payroll departments in correctly managing trainee paperwork & pay.

Minimum rotational duration of a placement should be 1 year, 6months for cardiac anaesthesia, & not 3 months. It takes a toll on the trainee’s personal & professional life to move around for such short duration.
AAs pose a threat to patient safety, are a burden on the healthcare system, and reduce training opportunities for doctors that have undergone a much more stringent training and recruitment process
Absolutely appalled and frankly disgusted at RCoA’s implied support of AAs. Please stop using the excuse that NHS England is pushing the AA workforce. The College has the option to oppose AAs, but has chosen not to. AAs are untrained, unsafe, a threat to the profession and I will relinquish my membership to the College if RCoA continues on this path.
Agree completely
All of the above and include an increase in the number of training places at all levels in order to meet the current widening consultant deficit and brain drain.
Also reduce costs for members
Anaesthesia associates may have a role but this needs to be more well planned and with limited role for expansion.
As a trainee who fell through ANRO gap it’s curriculum changes and lack of training numbers I am now having to put myself through CESR pathway. I am UK trained. ANRO is disgrace and fact that pathway is not run through is shambolic and essentially alienates those who have taken a break or not a trainee consistently. The lack of numbers in some regions is ridiculous and as such the making up of numbers of AA trainees increases the farce.
As an ACCS anesthesia trainee, I do feel deflated when thinking about my future career. With the ST4 bottleneck, and the rise of AAs, it appears as though the college does not have the best interests of its paying members.
Awful experiences with ANRO.
Between the predictable and avoidable ST3 recruitment debacle, huge training bottlenecks and impositions of AAs, the College is longer advocating for patients undergoing anaesthesia. It now faces a binary choice between changing its approach or obsolescence.
Consultants should have free choice whether to be involved in supervision or training of AAs and this should not be mandated or a pre requisite for any consultant anaesthetist job
Continuing to ignore the majority views of your body in favour of the views of a select careerist few will inevitably lead to similar action. Doctors are standing up – don’t be part of the problem.
East of England deanery has AAs supervising novice anaesthetists (with the consultant out of theatre) – this is unacceptable as novice anaesthetists are in their most impressionable stage of their training career, and should be supervised by doctors who will have passed the FRCA/working to pass the FRCA or equivalent overseas examinations. This is because the Anaesthetic trainees will become more senior doctors, and hence should have the fundamentals of their anaesthetic practice taught by appropriately qualified anaesthetists, not AAs.
excellent trainees fail to move into national training, get stuck .in spite of frca.
aas are not the answer and shouldn’t take away training opportunities.
Excessive rotation during training disrupts lives. It has a massive negative impact on relationships in and outside work, it encourages long commutes which is bad for the environment, and it is bad for our finances because it delays our ability to buy a house. It must be stopped.
Expansion of AAs to plug gaps in the service whilst simultaneously reducing the number of ST4 posts is highly disingenuous. The college has previously pointed to an extra 210 ST4 posts being created, however the timeframe is vague and the location of these posts are unclear. This also follows a number of years of declining national posts and a bottleneck created by the college due to a poorly thought out cirriculum change. There was an opportunity to make anaesthetic training run through like it is in many other peer countries, this would have given trainees more control over where they live and train, allowing better life-planning around support networks. However, it does not appear the college gave this much consideration and instead created an environment where the training of AAs seems to be more of a priority than the training of future anaesthetic consultants.
Feeling completely hopeless so early in my career seeing the collage support AA but continue to reduce training opportunities to AiT. As someone nearing the desperate position of an ST4 number knowing I will possibly having to take years out and having to factor in worries around maternity pay, I find it extremely upsetting that the collage doesn’t support run through training and prioritise the AiT that have already sacrificed so much.
Fees should not be compulsory
I am disappointed it hasn’t been the College leading this movement. What was once known as an institution hellbent on patient safety & the welfare of its members feels like a shadow of its former self.
I’m grateful at least there are mechanisms where the College aren’t prepared to lead through the work of what are brave consultants/SAS and trainees we as a wider membership have been allowed an opportunity to have a say in this matter.
I am disappointed that the college seems to become divorced from understanding and supporting it’s core membership. The move to non-physician anaesthetists devalues our profession, undermines medically qualified anaesthetists in training and risks compromising safety directly and indirectly.
I am disgusted by your actions to attempt to water down what should be the most safety-conscious of all specialties. The above AA issues WILL result in patient harm and WILL undermine the standing of Anaesthesia as a specialty.
I am in full time independent practice and I am very worried about the future of our profession. The Royal College and the AAGBI have both been asleep at the wheel. I am happy to help with the campaign
I am totally against the expansion of AA when training numbers are being restricted. The rcoa must desist and oppose the roll out of AA
I and my colleagues feel thr colleges support in developing an AA curriculum and framework whilst saying your main priority is ST4 recruitment expansion is fundamentally contradictory.
I do not support the introduction of AA’S and will not train or supervise them
I feel AAs are a huge threat to patient safety. It’s sad to see doctors who work hard to become anaesthetists bring disenfranchised by their own like this.
I feel totally abandoned as a trainee stuck in the bottleneck. You changed the curriculum with total disregard to us as a cohort. On top of that, you have and are facilitating the expansion of AAs which are a direct threat to anaesthetists. You are supposed to be our college, not some non-doctors.
I fully support these motions and disagree strongly with the route that the college has taken so far. We are anaesthetists and there can be no substitute. The college should exist to protect and sustain the quality of anaesthesia in this country regardless of the government’s view. This should be a reminder of that.
I fully support this initiative and the individual motions. There are more than sufficient numbers of interested colleagues to take up anaesthetic training, and recruitment has been handled poorly, especially in recent years. Anaesthetic associates like all their PA brethren are being brought in without proper consideration and consultation, as a short-term stopgap that will bring unintended consequences. The timeframe until the shortage provides ample time to build a sufficient consultant workforce if the appropriate steps are taken now.
I have a complete lack of confidence in the ability of current RCoA to represent myself and our specialty effectively
I have been adversely affected by a number of the issues around training and I think that this all needs to be discussed at a wider level rather than decisions made by a small number of people in a manner that does not seem to reflect the opinions of the wider membership.
I have completed half on anaesthetic training. I can now not continue this because of the farce run by the college and recruitment planning. Thanks for ruining my career aspirations.
I have given up my college membership because of the above.
I have many grave concerns regarding expansion of AAs that have not been addressed by the college. Fundamentally it will mean worse care for patients and consultants being stretched even further and worsen the trainee experience at all grades.
Any AA training program must be fully regulated by the RCoA with rigorous academic and in placement portfolio requirements equal to to those of the at least primary FRCA/ core trainee, if this is the sort of level AAs are expected to work at. There should also be a clear ceiling of practice set nationally for AAs.
I have no interest in supervising and taking responsibility for an unregulated profession. How can you force us to train individuals to do a job other than our own?
I have personally been removed from training lists to give AAs training opportunities. This added extra stress to getting necessary sign-offs. The lists I have been removed from were lists that I had specifically requested.
I have previously emailed my concerns in writing to the college re AA expansion. Concern chiefly of their ability to curtail an expansion of numbers that ultimately would replace physician Anaesthetic workforce
I hope the college will listen to the voice of its members.
I left college after RCOA talk at Birmingham.
There is bias towards AAs best lists. Our trainees can’t nos
and are leaving to Australia.
Hamish McLure said at Birmingham this is coming whether you like it at not. He also used the term poaching
In my hospital if you don’t agree to supervise AAs in day unit you will be moved as a Consultant. Our trainees are being treated badly in my opinion. AAs get best lists our trainees don’t always.

To solve work force problems more nos for trainees give them
Hope. Will lead to better care for patients.

In the end you have to decide whether it’s worth doing medicine or do a nursing/odp degree to administer anaesthetics in UK
I oppose the introduction and use of AAs. Anaesthesia should be a physician-only profession.
I simple answer to your workforce issue is to actually give all your appointable interview candidates currently a training number. There’s a 3 to 1 ratio for anaesthetic training among doctors. In addition in other countries anaesthetic training is 3-5 years post- medical school. Whereas in the uk it’s 8 years plus foundation training. The answers are simple and they don’t involve AAs
I support the idea that AAs have a place in the UK, but that expansion in place of registrars is wrong, and that their scope should be limited and clearly defined.
I would like AA to be only responsible monitoring case under guidance of independent medically qualified Anaesthetic doctor.

Anyone who would like to practice anaesthesia independent must go through medical school and train as an anaesthetic doctor.
I would like to point out that 1) in the current poor AiT recruitment climate, every AA is taking a training opportunity away from a potential trainee; 2) one consultant cannot be immediately available to multiple AAs and as such this model of working is substandard and non-viable.
If there is funding available to train AAs could this be put towards expanding ST4 anaesthetic trainee jobs to help with the bottleneck? Doctors who have already trained (for at least 11years) in this profession are unable to progress, however, there is funding available to train AAs? I support the expansion of the workforce, however, there are huge numbers of post-FY2 doctors that would love to train in anaesthetics that are unable due to limited doctor training numbers. If AAs are going to be supervised akin to trainees, I believe they should have to undergo the same breadth of hospital rotations, after hours shifts, breadth of exams and ward experience to gain the relevant exposure that isn’t always provided at one hospital in-hours or trainees should be offered the same advantages as being an AA (for example staying in one area and allowing doctors to apply for AA roles should they wish to remain in a hospital). Rotational training is humbling and I believe prevents over confidence. I worry that remaining in one hospital will allow AAs preferential training over trainees due to departmental trust that is built over time, as a result friction with existing trainees is unavoidable. For example, a departmental ODP is offered ALS by the trust as it benefits the trust, however, an anaesthetic trainee has to pay for resuscitation courses out of their own salary unless they have passed all their exams. It is likely a department will preferentially train a permanent AA member of staff versus a rotational trainee. In order to work seamlessly alongside one another there needs to be delineation in job role (including separate college) and importantly separate clinical accountability when working together with trainees. My experience of the Australian healthcare system was that there was greater delineation of job roles which meant team members could work more cohesively together.
In addition to the motions put forward to an EGM, I would like the RCoA to take a robust stance on the use of anaesthetists in training to prop up ICU rotas. It has been over ten years since ICM and Anaesthesia training were separated. We must stop allocating anaesthetists in training to shifts on ICU for any time beyond that demanded by the training curriculum.
Incompressible and unfair allowing multiple cohorts of trainees through core training but prevent them progressing any further, effectively wasting 3-4 years of their life.
Increase anaesthetics training numbers for medical doctors and restrict the numbers and opportunities for AAs.
It is outrageous that expansion of AA numbers can be considered when there is a recruitment crisis at entry to both stage 1 and particularly stage 2 training. Scores of trainees are unable to obtain a job in a region of their choosing, despite completing core/ACCS training and undertaking rigorous exams, the content of which is mostly of no use to modern clinical practice. Furthermore, these exams are self-funded and trainees are expected to revise in their own time, with no remuneration.
The RCOA need to value their trainees and increase training numbers immediately.
It is time to stop this nonsense expansion of AA and support your own Anaesthetists. I am caught in this bottleneck and it is has ruined my life. I am a depressed and now uncomfortable person and very angry with how I have been treated. ANRO needs to be dismantled. It is not fit for purpose. And please time is up for rotational training
It is untenable that the College is not already directly opposing the expansion of AAs. The College is meant to represent its members and it is abundantly clear that the majority of members do not support such expansion. How is it that an appointable anaesthetist in training, with the FRCA part 1 completed, a medical degree, and at least five years of working as a qualified doctor, is denied career progression for no valid reason while NHSE support anaesthesia delivered by people with a 2:1 in biomedical science (about 12 contact hours a week in term time and a relative walk in the park compared to a medical degree – having done both) and a 2 year crash course in the practical basics of giving a simple anaesthetic. The anaesthesia associate curriculum is nebulous and gives no indication of any specific physiological and pharmacological knowledge required. I don’t believe there is even an examination but if the PA exam is anything to go by, along with the AAs and PAs that I have worked with, then the fundamental knowledge underpinning anaesthesia will be severely lacking. I know many people who have been stuck behind the ST bottleneck for years, in their late 30s and early 40s, who have had time out of training to raise children, who simply do not have the time or money to jump through the arbitrary hoops of being the first author on published papers, self-funding another degree or PhD, leading a national audit project, entering the Olympics, or organising DofE trips. Equally I know many trust grade anaesthetists who spend all their free time, as well as much of their work time, jumping through these hoops so as to outcompete excellent anaesthetists with great patient manner, medical knowledge, and practical acumen. The recruitment system in its current state is broken and does not successfully reward good anaesthetists. The ANRO debacle of an employee somewhere deciding what MSRA score a candidate would have probably achieved based on nothing but a hunch is damning. We supposedly have an impending catastrophic shortage of anaesthetists nationwide, so any appointable anaesthetic CT3+ should be offered a job somewhere to begin to correct this; particularly while more AA posts are being created. For a speciality focussed on evidence and safety, I cannot believe that people without medical training are being allowed to anaesthetise human beings in this country with local supervision. It is unfathomable. There is no other area of medicine where a patient puts their life in the hands of a doctor quite as literally as anaesthesia. I would not be willing to be anaesthetised by an anaesthetic associate, I would not want my family to be anaesthetised by an anaesthetic associate, and thus I extend this sentiment to all of our potential patients. This is the firm stance of all other anaesthetists and consultants whom I work with. So how can the College simply stand back and accept their expansion without taking action and refusing to allow AAs to work with anything less than direct consultant supervision. Being an anaesthetist relies on expert knowledge accrued through years upon years of medical training and wider reading. Moreover who is the College expecting to consent to supervise AAs in the future? This generation of core trainees, registrars and consultants, never consented to being responsible for multiple anaesthetics at once being led by undertrained non-doctors. The overriding sentiment from our colleagues is that they will simply to refuse to have their license to practise hinge on the skills of someone with a 2:1 in a life sciences course and a couple of years of on-the-job training and nothing even approaching an FRCA level of knowledge. This is not a long term plan.
It seems like we are at a crossroads and this is the only way to ensure patient safety
It’s time to listen to the views of the anaesthetists who’s subscriptions pay for the upkeep of the college
Lack of registrar training jobs is stressful, unfair and extremely discouraging, makes us feel unvalued and unimportant. Also, having AAs taking up trainee spots meaning hospitals can take fewer trainees is unacceptable- it seems the college is supporting a reduction in anaesthetists. Similarly, having AAs do day case lists- these are perfect training opportunities for core trainees. Similarly AAs do not have to rotate, start on a better salary than core trainees and have less responsibility- how is this fair? Why have I studied and worked hard for so many years and done the primary when someone with much less experience and medical training is allowed to do the same job as me and get paid more without the huge disruption of rotational training and stress of exams?

I do not feel strongly either way regarding centralised vs non centralised recruitment.
Many thanks for the ongoing engagement, it is overall, a very uncertain and anxious time to be a trainee.
My job satisfaction is at an all time low, i feel undervalued by the college and by NHS England. I want to continue you doing the job i love but things have to get better.
My personal life has been dramatically impacted by having to uproot myself geographically from my partner, friends and family due to training requirements. The current impersonal system has never (since medical school interviews) considered me as an individual both outside work, but also within work.
No confidence in the approach to AAs , or to RCoAs approach to managing anaesthesia training
Not a message for the college – a message for the team behind Anaesthetists United – thank you for standing up for our profession. As a core trainee it has felt absolutely despairing looking at the future / in my case potentially lack of a future in this specialty due to training bottlenecks etc! Thank you thank you thank you for caring and for providing some glimmer of hope.
Not only is the expansion of AA’s undermining anaesthetists, it is undermining doctors in general. How on earth are we going to attract bright, intelligent people into the profession in the future when morale, pay and integrity are critically threatened.
Please be more supportive of anaesthetists in training and make it a priority to look after the anaesthetist members of the college, both consultants and anaesthetists in training.
Please consider run through Anaesthetics training
Please have the bravery to stand up to the government and oppose AA expansion. This will force them to seriously increase training numbers and help fix the bottleneck and ensure safe and high quality anaesthetic care in the future.
Please look to the veterinary industry which works in a format similar to proposed AAs but with VNs. There are significant safety issues and poor outcomes and poor patient experiences and medicine can look to the problems inherent in this industry to see why this is a poor idea. Also please review ANRO, rotational training (especially where it is not required ie. For specialities that are widely locally available) and centralised recruitment before you lose valuable and experienced trainees. I joined medicine purely to be an anaesthetist but won’t be able to if these things continue.
Please make some meaningful change for trainees. Talking about how you are lobbying without any realistic demonstrable change is extraordinarily frustrating for trainees in this specialty.
Please oppose the demedicalisation of anaesthetic practice
Please stop the expansion of AAs. Nobody should be anaesthetised by an unregistered practitioner without a medical degree. It will lead to negative outcomes for anaesthetists and patients.
Please stop this AA expansion. You have the power. I don’t think you realise you’re own strength. I am desperate to continue my career in anaesthetics that I love but the st4 bottleneck and 2 babies at home is causing me so much stress regarding moving. I will have to CESR/portfolio pathway because I just can’t take the massive upheaval and mediocre salary relative to the high intensity and responsibility. Please end the bottleneck. Again you have the power. The government need to listen to us.
Put doctors interests first
Rather than expanding AAs I would suggest expanding training posts AND shortening training to 4-5 years (in line with most other comparable countries) and get these post-FRCA doctors working with increased autonomy as associate specialists. Give them the opportunity to do post-training fellowships if they want to develop specialty interests, or allow them to apply for DGH consultant posts after a 2 year post as an autonomous associate specialist. Thus consultants would still have a minimum of 7 years experience, but workforce gaps are plugged, and repetitive tedious training is curtailed.
Regarding rotational training and recruitment: after pay, I feel that these are the most detrimental factors in doctor morale and can be so easily modified with College support. I am glad to support a motion encouraging the RCoA to examine the detrimental effect these factors have on its members.
Rotational training (3 monthly job changes) is ruinous to one’s personal life and to professional relationships. It is stressful and it is often costly due to frequent pay errors. The ends do not justify the means. It must stop. Limit rotations to yearly at most.
Rotational training and the fact that there is no option for run through training in Anaesthetics has massively destabilised my life and many of my colleagues. There is no need for it to be this difficult to get an ST4 job in the area you have done core training. Rotations in reg years are too short. It would be easier for people to have a base hospital (where people know you and there is accountability) and do rotations in the tertiary centres as needed.
Should have engaged the membership before the generalised response to the workforce training plan. This has been a long time coming.
Signed up to ACCS anaesthetics as 3 year programme. Changed to 4 years without my knowledge or update in contract. Totally demoralised with 6monthly rotations between Newcastle, Carlisle and Middlesbrough + more. Low chance of getting ST4 job even after jumping through every hoop put in front of me.
Supporting AAs is completely undermining the profession of anaesthesia and needs to be stopped.
Thank you. We are really need such move.
The anaesthetics had the same level of reputation as surgeons because of the meticulous training and exam as was launched. Having AA do the same work or similar work is not helpful, we are diluting the experience and knowledge a person should have to give anaesthetics. In long term we will make our lives difficult. The consultants will have more burnout supervising AA than anaesthetic trainees. No one will want to do anaesthetic training in long run. We will be left with burnout consultants and eventually no consultants.. this is a vicious cycle. Please do not bring AA. Don’t make the same mistake. See the bigger picture.
U have many img, experienced doctors. Make CESR a better pathway, u will have better trained, better experienced people who will be happy to work.
The Charter of the RCoA is clear in the responsibilities of the College – ‘to maintain the highest possible standards of professional competence in the practice of anaesthesia for the protection and benefit of the public’.

The movement towards an Anaesthetic Associate workforce – lesser trained, lesser experienced, and lesser qualified – and their expanding numbers (to the detriment of medically qualified anaesthetists-in-training) is in direct opposition to this Charter.

The College leadership must either uphold their own Charter and it’s aims, strengthened through the above resolutions, or step aside for leaders who will.
The college exists to drive standards higher.
The college has a responsibility to not succumb to whatever uninsightful decisions are thrusted upon them by a government or health system lacking foresight, especially when it comes to standards in the practice of anaesthesia.
The College has lost touch with its members. Unless urgent steps are taken to deal with these issues, the future of anaesthesia in this country is at stake.
I do not fancy having an AA anaesthetise me when I come for my fractured hip- unless there is direct supervision by a Consultant Anaesthetist. Stop thinking costs (this is the 6th largest economy in the world) and start thinking standards and safety.
The college have not read the room on the topic of AAs. This workforce needs more consultant anaesthetists, which means more medically trained anaesthetic trainees. There is no role for expanding AA numbers; the college should vociferously oppose this in favour of expanding AiT numbers.
The college have to denounce AAs in no uncertain terms. No wooly excuses placing the blame on govt, they have to take responsibility of their position & say they do not think AAs should exist & it’s a danger to patient care.
The college must demonstrate support for the development and wellbeing of anaesthetic doctors first and foremost, above all other interests. Our trainees are in crisis, with limited training opportunity and low morale. The college must start taking bold steps to improve their situation if anaesthesia is to remain an attractive and fulfilling career choice for doctors.
The college must recognise the strength of members feelings about these issues.
The college need to remember that they work for us, the doctors. Not the government. Grow a backbone and stand up for what’s right.
The college needs to engage with its members views and remember its reason for existing.
The College needs to represent its members. The expansion of the AA role is a slippery slope. There will undoubtedly be a deterioration in training for AITs, just like every other specialty in the NHS. The RCOA needs to exercise its influence/soft power and oppose the expansion of the AA role. This is for the future of the specialty! If the college doesn’t act now, I guarantee you, we will look back on this in 10-15 years time and absolutely regret it
The college needs to stand up to the ongoing degradation of the profession and protect its members from expansion of AAs, sub standard recruitment and dehumanising treatment of trainee anaesthetists.
The college stemmed from the RCS as a institution to better the anaesthetists of the nation and to encourage the study of anaesthetics, not dilute the study of anaesthetics.
The college’s position on AAs is a disgrace.
Patient safety is every Anaesthetist’s priority, and I would not be prepared to be looked after by a non medical Associate.
The college should pay attention to the members it represents.
Massive change is required in the way ordinary clinicians are represented and supported.
The curriculum change in 2021 was absolutely devastating to my career. It led to 2 years of uncertainty and little guidance or support from the college. I felt completely abandoned. It felt as if the college was trying to close the door on us and brush us under the carpet. I know so many excellent trainees caught out by this.

The current rules regarding recruitment to dual training are awful. I spent 2 years trying to obtain a second training number in the same deanery as my ICM number before becoming close to running out of time. Dual training numbers do not require additional funding.

In addition to this in the 2021 recruitment round anaesthesia numbers were given out beyond the deadline for acceptance and offers. This meant lower ranked candidates who had only ranked a single deanery were offered places over higher candidates.

I am so disheartened by the colleges decision and lack of support for us as trainees over the last 3 years.
The development and expansion of AAs must stop. We as a anaesthetic body must not allow AAs to exist. It is a completely different way of working and patient care that needs careful planning. RCOA should make a strong statement saying that until it has been looked into completely we will NOT support the development of a whole new tier of anaesthetic providers. Frankly I am surprised the college has pushed forward so far with this. I am very disappointed by the lack of engagement with members.
The entire process of recruitment in recent years has left the majority of trainees feeling devalued and demotivated. Constant discussions of shortages of anaesthetists whilst continuing to expand AA numbers has also been particularly galling whilst so many valued and excellent colleagues have struggled or failed to obtain specialty training numbers. It is unsurprising to see so many now opting for the CESR route, going abroad or leaving the specialty completely.
The expansion of AAs is a politically driven process that is not in the interests of both patients and anaesthetists in training.
I work in a large tertiary centre with a major trauma service. AAs have been introduced – I see no role for them. I personally opposed their introduction but my opinion as a senior Consultant was ignored, like others within my department.
The increasing expansion of AAs is having a noticeable impact on rota practices and training. It’s very easy to not put trainees in theatres where an AA is, but in doing so they are missing out training opportunities within that sub specialty. This has happened with opthalmic and regional anaesthesia in my experience
The RCOA must start representing the views of its members or risk mass non-payment of membership fees.
The reason I am saying no to expansion of AAs is that at present I have seen how difficult it is to provide safe training to AAs and the universities doing the programme seems to be rushing it to get it done rather than actually imparting the core knowledge.
The recruitment to Anaesthetics training is an absolute shambles and has made it into the national headlines. The College needs to act decisively to restore faith in the process. ANRO is not fit for purpose and needs to be fundamentally reformed. I do not necessarily oppose the expansion of AAs but I think that expansion needs to be done in a controlled and considered manner rather than as a rapid knee jerk response, and its impact on trainees must be looked into very carefully.
The threat of AAs, ANRO and recruitment, and rotational training has made me reconsider a career in anaesthetics very quickly after commencing, and we need to see the College act to change this before you lose me and others like me
The time for change is now.

Enough of the cheap replacement of consultant delivered care, enough of pandering to the governments agenda, and enough of scope screep from ODP+ colleagues who want to give anesthesia by pattern recognition without any medical training.

Enough is enough. Change now or be replaced.
The way the information on this website (https://anaesthetistsunited.com/sign-up-now/) is displayed is very clear and the people that made this should be involved in dissemination
of information for the rcoa including training and recruitment.
The way trainees have been treated and supported by the college is appalling. The curriculum change, the portfolio problems, the non functioning recruitment, the pushing through of AAs.
There is far too much ‘local governance’ knocking around regarding AAs – variable ‘scope’ with unclear training and can be very challenging to discuss this with consultants when you’re a new trainee. It’s unfair and unsafe. RCOA cannot in good faith support AA expansion given the above. Patients deserve better. Be better.
There should be proper debate about these issues. We should not sleepwalk into a position where skilled anaesthetists are devalued in favour of associates with less training and currently far less accountability
These resolutions are the first step towards the RCoA putting its members first, and doing what is right and necessary to protect both patients and anaesthetists in training. I sincerely hope that this requisition of an extraordinary general meeting demonstrates to the committee that the next generation of anaesthetists will not stand idly by whilst our training is blighted by the forced expansion of less qualified and unregulated physician assistants (anaesthesia).
These topics need formal addressing by the College or else we risk alienating an entire generation or anaesthetists. With the difficulty in retention, we cannot afford not to acknowledge and address the issues that lead to trainee disillusionment and eventual abandonment of the NHS if we want a functioning British Anaesthetic service over the coming decades.
They should be representing the membership not following the whims of the government. Once there’s a significant expansion of AAs to the point AAs train AAs we lose control over the provision of anaesthesics in this country. Just look what’s happening with A&E and Medicine.
This doesn’t affect me, I’ve already left for an Australasian college and training programme
This is terribly important for UK anaesthesia
This may be the last year I pay for membership of the College because of the complete lack of advocacy for specialists in the UK
Though not covered by these motions, I also think the college should be taking more dramatic action to address the ludicrous bottleneck between CT and ST training. The Trust I work for is aggressively recruiting staff grade anaesthetists from abroad due to a shortage of middle grades to staff their rota, yet all the CTs fear that they will not be able to get a post despite meeting all their training goals and having good CVs. This is a shocking situation.
To expand AAs and not tackle the lack of training numbers is to accept failure in the role of anaesthetists. I will not be a part of this. Take action now, such that we can feel safe when in our moment of need.
Train doctors not Noctors
Trainees are our future and most precious resource, to nurture and encourage, enable and allow to flourish. They are subject to constant bullying pedantry by our college. If you are going to insist on absolute administrative efficiency in your trainees it’s a good idea to set a better example.
Trainees have been seriously let down by the college over the past few years. ITU relied on anaesthetic trainees during the height of the pandemic and those trainees appear to have been penalised by poor recruiting policy. We should prioritise the doctors who wish to train within anaesthetics when there is such a projected shortfall in required numbers in the coming years. AAs cannot replace anaesthetists to be fair I am entirely unsure of what purpose they serve in our current system.
Very happy to pause/ cancel my subscription to the college if it helps them to get the message.
We change or the specialty dies. You need to get the views of the hard working clinicians that dont have the time to be on all the committees as they work full time. You are failing these doctors.
We need to stand up to HEE, we need to ensure funding for future anaesthetists. We need college to convey depth of feeling amongst trainees and consultants as regards a lack of rank and file consultation
We should oppose the expansion of non-doctor / non-nurse medical roles.
Whilst I am not entirely against AA, this cannot be done without expanding training for anaesthetists who will be necessary to provide supervision in the future. I do not think the public is aware they are not doctors.
The training is not the same, and AAs do not have to suffer the sacrifices doctors do in terms of application to training, difficulty of exams, requirements to relocate, lack of job security between lower and higher training etc. From what I understand trainee AA pay is higher than CT1s training at the same level which does not help relations in the work force. I think there is a major concern expanding AAs will lead to further discontent within the profession, and is a cause of concern for future retention of anaesthetists. As a doctor I have been to prepared to make sacrifices if there is a clear end, but the goalposts keep changing, pay has been eroded, and if you can employ someone cheaper to do the same job, we will be left with student debt and burnout and there may not even be jobs for us at the end of training? You start to ask yourself if it is all worth it.
Why do AAs get paid more than an anaesthetic SHO. We impose a second tier of anaesthetist which can’t contribute to on calls.
With costs going up and pay going down (in line with inflation) I am getting to a point I can’t afford to stay in medicine with costs associated with regional travel.
It would be a better lifestyle for me to (ironically) become an AA! Better work-life balance, less responsibility and better pay!
You brought this upon yourselves by failing to act in the interest of anaesthetists for years and overseeing multiple catastrophes with no one evidently being held accountable. I hope this group takes the next step and sets up unity candidates to contest the elected council positions- they will win.
You can not expect to pay people the same as a registrar when they have done less to get there and work fewer hours and less of those being out of hours.
You don’t listen to your members. We pay you to represent us but you don’t. This is what happens.
You have really messed things up and are not supporting safe expansion of training of independent anaesthetists. Shame on you !
You need to start representing us properly.